Provider Demographics
NPI:1942220199
Name:PALMADESSA, DONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:PALMADESSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24102 NORTHERN BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1061
Mailing Address - Country:US
Mailing Address - Phone:718-461-0163
Mailing Address - Fax:718-358-5570
Practice Address - Street 1:24102 NORTHERN BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1061
Practice Address - Country:US
Practice Address - Phone:718-461-0163
Practice Address - Fax:718-358-5570
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00847576Medicaid
NY00847576Medicaid
NYB87912Medicare UPIN